SOUTHEASTERN RETINA ASSOCIATES P.C. NPI 1932370145

NPI Information

NPI: 1932370145
Provider Name: SOUTHEASTERN RETINA ASSOCIATES, P.C.
Classification: Ophthalmology - 207WX0107X
Entity Type: Organization

Specialization: Retina Specialist

Address:
2412 N JOHN B DENNIS HWY
KINGSPORT, TN
ZIP 37660
Phone: (423) 578-4364
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SOUTHEASTERN RETINA ASSOCIATES, P.C. is a retina specialist ophthalmology in Kingsport, TN. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. SOUTHEASTERN RETINA ASSOCIATES, P.C. NPI is 1932370145. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2412 N JOHN B DENNIS HWY
KINGSPORT, TN
ZIP 37660-772
Phone: (423) 578-4364
Fax: (423) 578-4372

The provider's authorized official is Andrew Laverghetta .
The authorized official title is Ceo and has the following contact phone number (865) 588-0811.

The enumeration date for this NPI number is 3/14/2008 and was last updated on 1/18/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207W00000X	Ophthalmology				No
2	207WX0107X	Ophthalmology	Retina Specialist			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CD7808	OTHER	TENNESSEE	RAILROAD MEDICARE
2	3715424	MEDICAID	TENNESSEE
3	89011K5	MEDICAID	NORTH CAROLINA
4	CG2897	OTHER	VIRGINIA	RAILROAD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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